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Rokotukset eivät lisää MS riskiä (Luettu 254 kertaa)
HopeSprings
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Rokotukset eivät lisää MS riskiä
02.08.2019 - 14:21:31
 
Vaccinations not a risk factor for multiple sclerosis

https://www.sciencedaily.com/releases/2019/07/190731113010.htm

July 31, 2019
Data from over 12,000 multiple sclerosis (MS) patients formed the basis of a study by the Technical University of Munich (TUM) which investigated the population's vaccination behavior in relation to MS. It showed that five years before their diagnosis, MS patients were statistically less likely to receive vaccinations than comparator groups. Consequently, there was no positive correlation between vaccinations and the development of MS.

MS is now thought to be a neurological autoimmune disease in which the immune system attacks the brain and spinal cord. It is most likely to occur in young people under the age of 40. Vaccinations are often mentioned as a possible risk factor for MS. Professor Bernhard Hemmer, director of the Neurology Department of the TUM hospital, Klinkum rechts der Isar, teamed up with scientists from the Medical Department and the Bavarian Association of Statutory Health Insurance Physicians (KVB) to analyze a large KVB dataset representative of the general population. The data covered over 200,000 individuals, including more than 12,000 MS patients. The study was published in the Tuesday, July 30, 2019, issue of Neurology, the medical journal of the American Academy of Neurology.

Lower vaccination rates among MS patients

The researchers found that five years before being diagnosed, individuals who went on to develop MS had received fewer vaccinations than those who did not develop MS. This applied to all the vaccines investigated: those against pneumococci, meningococci, mumps, measles, rubella, chickenpox, human papilloma virus (HPV), hepatitis A and B, tick-borne encephalitis (TBE) and influenza. The effect was particularly pronounced in the latter three cases: the control group had received significantly more vaccinations than the individuals who later developed MS.

"The causes are still a mystery. It may be that people perceive the disease long before they are diagnosed and therefore avoid putting additional stress on their immune system. Such effects are in fact evident in our data. Or perhaps the vaccines have a protective effect that prevents the immune system from attacking the nervous system. In any case, given the large volume of data analyzed, we can conclusively state that there is no evidence that recent vaccination increases the likelihood of MS or the onset of an initial MS episode," Alexander Hapfelmeier, lead author of the study, explains.

Effect not evident in Crohn's disease or psoriasis

The researchers also wanted to rule out the possibility that the results might be an underlying effect of chronic diseases in general. They therefore analyzed data from two other groups: patients with Crohn's disease, an inflammatory bowel disorder, and patients with psoriasis, a chronic skin disease. The vaccinations of these patients had also been recorded five years before their diagnosis.

Those patients, however, had received as many vaccinations as the healthy control group. "Thus, the results are not due solely to the presence of a chronic inflammatory disease, but to behavior specific to MS," Bernhard Hemmer says, adding: "We already know from other studies that MS sufferers show atypical behavior and medical history long before they are diagnosed. For example, they are more prone to mental illnesses and also tend to have fewer children. All this clearly indicates that MS is perceived long before any neurological symptoms appear. We therefore need to find suitable markers to diagnose the condition earlier. We see this as one of our most important tasks."

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HopeSprings
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Re: Rokotukset eivät lisää MS riskiä
Vastaus #1 - 03.08.2019 - 00:12:06
 
Measles a known unknown

https://multiple-sclerosis-research.org/2019/07/measles-a-known-unknown/

I was called to casualty to assess one of my patients with MS who was on natalizumab. She had been admitted with a temperature, confusion, seizures and a generalised skin rash. Within thirty minutes of seeing her, she went into status epilepticus and had to be sedated, intubated and admitted to ITU. Within 72 hours she was dead. At post-mortem, she had a measles pan-encephalitis. Four days before presentation she had unknowingly come into contact with a friend’s child who had measles. The friend was a staunch anti-vaxxer who believed that the measles vaccine caused autism and would corrupt her child’s immune system.

The above scenario is fictitious, but could happen, or more likely will happen sometime in the near future. This is a ‘known unknown’.

Things have a tendency to happen in threes; I experienced two today let’s hope the third remains science fiction.

(1) As I left home this morning on my daily commute to Whitechapel I finished listening to an Audm podcast “FEAR, MISINFORMATION, AND MEASLES SPREAD IN BROOKLYN” by Amanda Schaffer (Wired,  24-06-2019); scary stuff about the real impact of the anti-VAXX campaign on residents in Brooklyn, New York.

(2) I followed this by reading a review about measles in the latest NEJM (Strebel & Orenstein. Measles. N Engl J Med. 2019 Jul 25;381(4):349-357), which reminded me of medical school and my time on the medical wards in South Africa.

I then had flashbacks to my days as a neurology registrar in South Africa seeing and managing many patients with SSPE (subacute sclerosing panencephalitis) a relatively rare, but fatal, complication of measles infection.

More recently there was a fatal case of measles inclusion body encephalitis presented at our Association of British Neurologists meeting; tragically this young woman had not been vaccinated against measles.

Why is this important? We are living through a measles epidemic. The anti-VAXX campaigners have convinced enough parents over the last two decades to not vaccinate their children against measles, mumps and rubella (MMR). Once a certain proportion of the population is not immune to measles, so-called herd immunity becomes ineffective; i.e. the shield offered by a population of people immune to measles is too porous to isolate susceptible people from wild-type infection in the community. In fact, vaccination works because of herd immunity.

Image from BioNinja

Another factor to consider is that unvaccinated people also get MS. If you are unvaccinated and have not been exposed to the wild virus you are now at relatively high-risk of acquiring measles as an adult. If you then decide to go onto longterm immunosuppression to treat your MS you are putting yourself at risk of serious complications from these infections, in particular measles. In addition, once you are on a longterm immunosuppressive therapy you can’t be vaccinated with the MMR vaccine as it is a live attenuated vaccine.

Measles is also a neurotropic virus and hence seeds to the brain. If you are on natalizumab and contract measles you will be in serious trouble. Natalizumab works by blocking trafficking of lymphocytes to the CNS and hence will stop your lymphocytes detecting, attacking and clearing the virus from the brain. The consequences of an unimpeded measles virus infection of the brain will be in all likelihood be lethal. This is a similar scenario to what happens with PML. Although natalizumab is being fingered here there is a risk will all of our immunosuppressive DMTs.

Because of this known unknown, I am proposing that all MSers are screened at baseline, i.e. before initiating a maintenance immunosuppressive therapy, to make sure they have immunity to MMR. If they are antibody negative they should be offered the option of receiving the MMR vaccine, or at least the individual components of the vaccine if they are still available in your country, to make sure they are immune to these viruses before they start treatment with the DMT concerned.

I sincerely hope my case scenario remains fiction and things don’t have to happen in threes.

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Koska rokottamattomat lisäävät kuoleman riskiä MS-potilailla, jotka ovat immunisuppresiivisella lääkityksellä, niin ennen lääkityksen aloittamista olisi huolehdittava, että kaikki rokotukset ovat kunnossa.  Itse olen sairastanut tulirokon, ja luulin kuolevani. Äitini myös luuli, että kuolen. Se on vakavasti otettava sairaus.
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